The Effectiveness of The Mini-Cog and MMSE As Vital Instrument Identifying Risk of Dementia As A Nursing Process Reinforcement

ABSTRACT West Kalimantan, majorly in density populated city-Pontianak- had not accurate statistic review about dementia and Alzheimer’s’s. Huge nursing care attention to elderly was put on physically as degenerative process, while emotional and memory either cognitive function were not clearly assessed. The purpose of this study was to compare the effectiveness of Mini-Cog and MMSE as valid instrument identifying and finding cognitive impairment in elderly which were leading to risk of dementia as part of nursing assessment. This was a cross-sectional study with 108 literate elderly of both genders at the outpatient clinics and shelters of Geriatricts and nursing homes in city of Pontianak dan district of Kubu Raya, West Kalimantan. Sensitivity and specificity of vital measurements the Mini-Cog were compared with those of the Mini- Mental State Exam (MMSE). Some factors-age, education, ethnicity, sleep duration- were tested to find its correlation to cognitive impairment. Results. All who met criteria for probable dementia based on informant interviews and with no revealed history of cognitive decline were included. Mini-Cog had the highest sensitivity and correctly classfied the greatest percentage (60,2 %) of subjects in state positive cognitive impairment. Moreover, MMSE had 53,7 % sensitivity to recognized “probable’ and “definite” cognitive impairment. The MMSE score was 21,88±11,309 which was in higher risk. Administration time for the Mini-Cog was 3 minutes while MMSE had 7 minutes. Conclusions. The Mini-Cog instrument is the easier way and more effective in revealing the risk of dementia with minimal language interpretation requirement and less training to administer than MMSE. Elderly in upper 60 ages is higher risk group to undergo cognitive impairment-range from mild to moderate even severe. KEY WORDS: dementia, cognitive impairment, nursing assessment, MMSE, clock draw test. ABSTRAK Kalimantan Barat, khususnya Pontianak belum memiliki data akurat tentang Demensia dan Alzheimer’s. Atensi mayor dalam proses keperawatan dan pelayanan kesehatan pada lansia rata-rata diletakkan pada aspek fisik yang terlihat, sementara aspek psikologis, emosi dan memori tidak terkaji dengan baik. Skrining status mental jarang dilakukan, tidak ada implikasi, dan tidak ada data kejadian Demensia resmi melalui Riset Kesehatan Dasar (Riskesdas). Tujuan penelitian ini adalah untuk membandingkan efektivitas Mini-Cog dan Mini Mental State Examination (MMSE) sebagai instrument valid dalam pengkajian keperawatan guna mengidentifikasi dan menemukan kerusakan kognitif lansia yang dapat mengakibatkan risiko demensia. Penelitian ini merupakan studi potong lintang dengan 108 partisipan lansia tidak buta huruf pada klinik rawat jalan dan panti lansia di Kota Pontianak dan Kabupaten Kubu Raya, Kalimantan Barat. Beberapa faktor seperti umur, pendidikan, etnis, dan durasi tidur diuji untuk menemukan korelasinya terhadap kerusakan kognitif. Parekrutan partisipan dilakukan berdasarkan wawancara kepada informan dan tidak ada riwayat didiagnosis penurunan fungsi kognitif sebelumnya. Berdasarkan temuan didapatkan bahwa Mini-Cog dengan tepat mengklasifikan persentase terbesar kerusakan kognitif yaitu 60,2 % state positif dan sebanyak 53,7 % mengalami state gangguan kognitif baik probable maupun definite menurut skoring Mini Mental State Examination (MMSE). Rerata nilai kognitif partisipan berdasar skoring MMSE adalah 21,88±11,309 yang berarti berada pada level risiko tinggi mengalami gangguan fungsi kognitif. Instrumen Mini-Cog sama efektif mengukur kemampuan kognitif lansia dalam 3 menit sedangkan MMSE efektif dalam waktu 7 menit. Instrumen Mini-Cog merupakan instrument yang lebih mudah bagi perawat dalam membantu menemukan risiko demensia tanpa terhalang oleh substanti Bahasa maupun etnis. Lansia pada usia lebih dari 60 tahun merupakan kelompok yang lebih tinggi mengalami kerusakan kognitif ringan hingga sangat berat yang berisiko pada kejadian demensia. KATA KUNCI: demensia, kerusakan kognitif, pengkajian keperawatan, MMSE, tes menggambar jam.

Clinical Aspects of Non-Alzheimer Disease Dementias

There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment

Clinical Aspects of Non-Alzheimer Disease Dementias

There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment

Clinical Aspects of Non-Alzheimer Disease Dementias

There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment

Clinical Aspects of Non-Alzheimer Disease Dementias

There are a relatively small number of disorders that account for the majority of dementia in the elderly that is not Alzheimer disease (AD): cerebrovascular disease, Lewy body disease (α-synucleinopathies), and the frontotemporal lobar degenerations. Cerebrovascular disease and Lewy body disease account for most non-AD dementia among persons in the eighth decade of life and beyond. These two frequently co-occur with AD but can occur in their pure forms rarely (in the case of dementia associated with cerebrovascular disease) or more commonly (in the case of Lewy body disease). There is no one cognitive or behavioral syndrome associated with cerebrovascular disease; however, attempts to isolate a common theme suggest that cognitive slowing is typical of cerebrovascular contributions to cognitive impairment. Cerebrovascular pathology relevant to cognitive impairment accumulates subclinically more commonly than it causes acute, strokelike declines in cognition. Dementia with Lewy bodies is a multidimensional disorder that includes a nonamnestic dementia, Parkinson disease or at least some parkinsonian features, a disorder of sleep and wakefulness, autonomic disturbances, and depression. The disorders of sleep prominently include rapid eye movement sleep behavior disorder, excessive daytime sleepiness, visual hallucinations, and marked fluctuations in level of alertness. The frontotemporal lobar degenerations are nearly as common as causes of dementia in persons under age 65 as is AD. The group of disorders includes two cognitive syndromes (primary progressive aphasia and behavior variant frontotemporal dementia) and two neuropathologic subtypes (tauopathy and TDP43 proteinopathy) and is associated with three major autosomal dominant genetic mutations (in MAPT, GRN, and C9ORF72). Key words: dementia with Lewy bodies, frontotemporal lobar degenerations, vascular cognitive impairment

Neurobiology of neuropsychiatric symptoms in Alzheimer's disease: A critical review with a focus on neuroimaging

ABSTRACT The objective of this critical review of the literature was to reveal the neural circuits involved in the occurrence of neuropsychiatric symptoms (NPS) in Alzheimer's disease (AD) patients through the association of these symptoms with neuroimaging findings. The search for articles was performed on PUBMED from January 2000 to May 2013, using the key words: Dementia AND BPSD; Dementia AND Neuropsychiatric Symptoms; and Dementia AND Psychosis, Delusions, Hallucinations, Agitation, Depression, Anxiety, Apathy, Euphoria, Disinhibition, Irritability, Aberrant Motor Behavior, Sleep or Eating Disorders. Forty-six articles were reviewed and important contributions, especially regarding the psychopathological concepts discussed, were also considered even if not included in this time period. The available evidence suggests the three most relevant neurobiological models for neuropsychiatric symptoms in Alzheimer's disease are the frontal-subcortical circuits, the cortico-cortical networks, and the monoaminergic system. We discussed the association of the individual symptoms or syndromes with these models.

Defisiensi Riboflavin dan Demensia pada Usia Lanjut

Demensia Alzheimer menempati urutan kesembilan penyebab kematian di Amerika Serikat. Demensia adalah kondisi yang sering dialami yang berhubungan dengan berbagai faktor dan gaya hidup terutama diet. Penelitian ini bertujuan untuk mengetahui hubungan defisiensi asupan riboflavin (vitamin B12) dengan demensia pada usia lanjut (usila). Penelitian ini menggunakan desain studi cross sectional dan dilaksanakanpada bulan September 2007 sampai dengan Januari 2008. Sampel penelitian adalah 141 lansia berumur lebih dari sama dengan 60 tahun yang diambil secara purposive sampling. Demensia diukur menggunakan kuesioner MMSE (² 24, skor maksimum 30) dan asupan riboflavin diukur menggunakan form Semi Quantitative – FFQ. Penelitian ini memperlihatkanbahwa 47,5% usila mengalami demensia. Hasil uji statistik menunjukkan bahwa terdapat hubungan yang signifikan antara umur, tingkat pendidikan, dan asupan riboflavin dengan kejadian demensia pada usila (nilai p < 0,05).Kata kunci: Demensia, defisiensi riboflavin, usia lanjutAbstractDementia Alzheimer’s was ranked the ninth leading cause of death in The United States. Dementia can not be avoided as related to several factors and lifestyle especially the diet. The objective of this research is to know relation the deficiency of riboflavine (vitamin B12) intake and incidence of dementiaat elderly. A cross-sectional study was conducted betweenSeptember 2007 and January 2008. The sample obtained was 141 elderly which it was conducted to purposive sampling. Dementia was measured by using questionnaire MMSE (² 24, maximum score was 30), and riboflavine intake was measure by Semi Quantitative – FFQ form. This study shows that dementia in elderly was 47,5%. Statistical test showed that Statistical test showed that incidence of dementia had significantly associated with ages, level of education, and riboflavine intake (p value < 0,05).Key words: Dementia, deficiency of riboflavine, elderl